22 Local Tetanus Uncommon formManifestations are restricted to muscles near the wound.Cramping and twisting in skeletal muscles surrounding the wound – local rigidityPrognosis – excellent

23 Cephalic Tetanus A rare form of local tetanusFollows head injury / ear infectionInvolves one / more facial cranial nervesTrismus and localised paralysis ,usually facial nerve, often unilateral.Incubation period : few daysMortality : high

25 Diagnosis Based entirely on clinical findingsExamine all cases with wound infection & muscle stiffnessWound cultures – in suspected cases C.tetani can be isolated from wounds of pts without tetanus & freq cannot be isolated from wounds of those with tetanusElectromyograms – continous discharge of motor units, shortening / absence of silent interval seen after AP.Muscle enzymes – raised